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open access

Vol 29, No 6 (2022)
Original Article
Submitted: 2022-05-20
Accepted: 2022-09-04
Published online: 2022-10-04
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Impact of heart failure on the clinical profile and outcomes in patients with atrial fibrillation treated with rivaroxaban. Data from the EMIR study

Manuel Anguita Sánchez1, Francisco Marín2, Jaime Masjuan3, Juan Cosín-Sales4, José Manuel Vázquez Rodríguez5, Vivencio Barrios6, Gonzalo Barón-Esquivias78, Iñaki Lekuona9, Alejandro I. Pérez-Cabeza10, Román Freixa-Pamias11, Francisco Javier Parra Jimenez12, Mohamed Monzer Khanji Khatib13, Carles Rafols Priu14, Marcelo Sanmartín Fernández15
DOI: 10.5603/CJ.a2022.0091
·
Pubmed: 36200548
·
Cardiol J 2022;29(6):936-947.
Affiliations
  1. Department of Cardiology, Hospital Reina Sofía Córdoba, IMIBIC, University of Cordoba, Spain
  2. Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBERCV, Murcia, Spain
  3. Servicio de Neurología, Hospital Universitario Ramón y Cajal, IRYCIS, Departamento de Medicina, Universidad de Alcalá. Red INVICTUS, Madrid, Spain
  4. Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
  5. Department of Cardiology, Complejo Hospitalario Universitario A Coruña, INIBIC, CIBERCV, A Coruña, Spain
  6. Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Alcalá University, Madrid, Spain
  7. Department of Cardiology, Hospital Universitario Virgen del Rocio, Universidad de Sevilla, Sevilla, Spain
  8. Unidad Cardiovascular, Instituto de Biotecnología de Sevilla, Centro de Investigación en Red Cardiovascular, Madrid, Spain
  9. Hospital Galdakao-Usansolo, Bizkaia, Spain
  10. Department of Cardiology, Hospital Virgen de la Victoria, CIBERCV, Málaga, Spain
  11. Department of Cardiology, Hospital Moisés Broggi, Barcelona, Spain
  12. Department of Cardiology, Centro Integral de Enfermedades Cardiovasculares, HM Hospitales, Madrid, Spain
  13. Department of Cardiology, Clínica LAMAR, Tomelloso (Ciudad Real), Spain
  14. Department of Medical Affairs, Bayer Hispania, Barcelona, Spain
  15. Department of Cardiology, Hospital Universitario Ramon y Cajal, Madrid, Spain

open access

Vol 29, No 6 (2022)
Original articles — Clinical cardiology
Submitted: 2022-05-20
Accepted: 2022-09-04
Published online: 2022-10-04

Abstract

Background: The aim of this study was to analyze the impact of the presence of heart failure (HF) on the clinical profile and outcomes in patients with atrial fibrillation (AF) anticoagulated with rivaroxaban.
Methods: Observational and non-interventional study that included AF adults recruited from 79 Spanish centers, anticoagulated with rivaroxaban ≥ 6 months before inclusion. Data were analyzed according to baseline HF status.
Results: Out of 1,433 patients, 326 (22.7%) had HF at baseline. Compared to patients without HF, HF patients were older (75.3 ± 9.9 vs. 73.8 ± 9.6 years; p = 0.01), had more diabetes (36.5% vs. 24.3%; p < 0.01), coronary artery disease (28.2% vs. 12.9%; p < 0.01), renal insufficiency (31.7% vs. 22.6%; p = 0.01), higher CHA2DS2-VASc (4.5 ± 1.6 vs. 3.2 ± 1.4; p < 0.01) and HAS-BLED (1.8 ± 1.1 vs. 1.5 ± 1.0; p < 0.01). After a median follow-up of 2.5 years, among HF patients, annual rates of stroke/systemic embolism/transient ischemic attack, major adverse cardiovascular events (MACE) (non-fatal myocardial infarction, revascularization and cardiovascular death), cardiovascular death, and major bleeding were 1.2%, 3.0%, 2.0%, and 1.4%, respectively. Compared to those patients without HF, HF patients had greater annual rates of MACE (3.0% vs. 0.5%; p < 0.01) and cardiovascular death (2.0% vs. 0.2%; p < 0.01), without significant differences regarding other outcomes, including thromboembolic or bleeding events. Previous HF was an independent predictor of MACE (odds ratio 3.4; 95% confidence interval 1.6–7.3; p = 0.002) but not for thromboembolic events or major bleeding.
Conclusions: Among AF patients anticoagulated with rivaroxaban, HF patients had a worse clinical profile and a higher MACE risk and cardiovascular mortality. HF was independently associated with the development of MACE, but not with thromboembolic events or major bleeding.

Abstract

Background: The aim of this study was to analyze the impact of the presence of heart failure (HF) on the clinical profile and outcomes in patients with atrial fibrillation (AF) anticoagulated with rivaroxaban.
Methods: Observational and non-interventional study that included AF adults recruited from 79 Spanish centers, anticoagulated with rivaroxaban ≥ 6 months before inclusion. Data were analyzed according to baseline HF status.
Results: Out of 1,433 patients, 326 (22.7%) had HF at baseline. Compared to patients without HF, HF patients were older (75.3 ± 9.9 vs. 73.8 ± 9.6 years; p = 0.01), had more diabetes (36.5% vs. 24.3%; p < 0.01), coronary artery disease (28.2% vs. 12.9%; p < 0.01), renal insufficiency (31.7% vs. 22.6%; p = 0.01), higher CHA2DS2-VASc (4.5 ± 1.6 vs. 3.2 ± 1.4; p < 0.01) and HAS-BLED (1.8 ± 1.1 vs. 1.5 ± 1.0; p < 0.01). After a median follow-up of 2.5 years, among HF patients, annual rates of stroke/systemic embolism/transient ischemic attack, major adverse cardiovascular events (MACE) (non-fatal myocardial infarction, revascularization and cardiovascular death), cardiovascular death, and major bleeding were 1.2%, 3.0%, 2.0%, and 1.4%, respectively. Compared to those patients without HF, HF patients had greater annual rates of MACE (3.0% vs. 0.5%; p < 0.01) and cardiovascular death (2.0% vs. 0.2%; p < 0.01), without significant differences regarding other outcomes, including thromboembolic or bleeding events. Previous HF was an independent predictor of MACE (odds ratio 3.4; 95% confidence interval 1.6–7.3; p = 0.002) but not for thromboembolic events or major bleeding.
Conclusions: Among AF patients anticoagulated with rivaroxaban, HF patients had a worse clinical profile and a higher MACE risk and cardiovascular mortality. HF was independently associated with the development of MACE, but not with thromboembolic events or major bleeding.

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Keywords

atrial fibrillation, bleeding, EMIR, heart failure, MACE, rivaroxaban, stroke

About this article
Title

Impact of heart failure on the clinical profile and outcomes in patients with atrial fibrillation treated with rivaroxaban. Data from the EMIR study

Journal

Cardiology Journal

Issue

Vol 29, No 6 (2022)

Article type

Original Article

Pages

936-947

Published online

2022-10-04

Page views

3604

Article views/downloads

509

DOI

10.5603/CJ.a2022.0091

Pubmed

36200548

Bibliographic record

Cardiol J 2022;29(6):936-947.

Keywords

atrial fibrillation
bleeding
EMIR
heart failure
MACE
rivaroxaban
stroke

Authors

Manuel Anguita Sánchez
Francisco Marín
Jaime Masjuan
Juan Cosín-Sales
José Manuel Vázquez Rodríguez
Vivencio Barrios
Gonzalo Barón-Esquivias
Iñaki Lekuona
Alejandro I. Pérez-Cabeza
Román Freixa-Pamias
Francisco Javier Parra Jimenez
Mohamed Monzer Khanji Khatib
Carles Rafols Priu
Marcelo Sanmartín Fernández

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